Preoperative inferior mesenteric artery embolization before endovascular aneurysm repair: decreased incidence of type II endoleak and aneurysm sac enlargement with 24-month follow-up.

PURPOSE

To review the effect of preoperative embolization of the inferior mesenteric artery (IMA) before endovascular aneurysm repair (EVAR) on subsequent endoleaks and aneurysm growth.

MATERIALS AND METHODS

Between August 2002 and May 2010, 108 patients underwent IMA embolization before EVAR. Coil embolization was performed in all patients in whom the IMA was successfully visualized and accessed during preoperative conventional angiography. In this cohort, the incidences of type II endoleak, aneurysm sac volume enlargement at 24 months, and repeat intervention were compared with a group of 158 consecutive patients with a patent IMA on preoperative computed tomography angiography but not on conventional angiography, who therefore did not undergo preoperative embolization.

RESULTS

The incidence of type II endoleak was significantly higher in patients not treated with embolization (49.4% [78 of 158] vs 34.3% [37 of 108]; P = .015). The incidence of secondary intervention for type II endoleak embolization was also significantly higher in those who did not undergo embolization (7.6% [12 of 158] vs 0.9% [one of 108]; P = .013). At 24 months, an increase in aneurysm sac volume was observed in 47% of patients in the nonembolized cohort (21 of 45), compared with 26% of patients in the embolized cohort (13 of 51; P = .03). No aneurysm ruptures or aneurysm-related deaths were observed in either group. One patient in the embolization group developed mesenteric ischemia and ultimately died.

CONCLUSIONS

Preoperative embolization of the IMA was associated with reduced incidences of type II endoleak, aneurysm sac volume enlargement at 24 months, and secondary intervention.